La disfunción de las pequeñas vías aéreas inducida por el tabaco ¿podría ser un marcador precoz de una futura EPOC? / Smoking-Induced Small Airway Dysfunction. An Early Marker of Future Copd?

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La e-basura: rare earth elements, nuevos tóxicos presentes en los cigarrillos y cigarrillos electrónicos / e-waste: Rare Earth Elements, New Toxic Substances in Cigarettes and Electronic Cigarettes

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La disfunción de las pequeñas vías aéreas deteriora la calidad de vida de fumadores sin limitación al flujo aéreo / Small Airway Dysfunction Impairs Quality of Life Among Smokers With No Airflow Limitation

Introducción: La disfunción de las pequeñas vías aéreas (DPV) inducida por el tabaco contribuye precozmente a la patogenia de la limitación al flujo aéreo (LFA), aunque resulta poco conocida su repercusión en la percepción de salud. Se pretende evaluar la frecuencia de DPV en fumadores activos sin LFA y comparar la calidad de vida relacionada con la salud (CVRS) de no fumadores, fumadores sin DPV, fumadores con DPV y fumadores con LFA. Métodos: En 53 fumadores activos sin LFA, 20 fumadores con LFA y 20 no fumadores, se utilizaron los cuestionarios SF-36 y EuroQoL y se realizó oscilometría de impulsos, espirometría y determinación de las densidades de atenuación del parénquima pulmonar en inspiración y espiración máximas. Se consideró que existía DPV cuando la resistencia a 5 Hz (R5), la diferencia R5-R20 y el área de reactancia (AX) excedían su límite superior de la normalidad. Resultados: El 35,8% de los fumadores sin LFA tenía DPV. No se detectaron diferencias en los parámetros espirométricos ni la atenuación pulmonar entre los fumadores con o sin DPV y los no fumadores. Sin embargo, los fumadores con DPV presentaban una peor puntuación en los cuestionarios de CVRS que los fumadores sin DPV o los no fumadores, e intermedia a los fumadores con LFA. R5 y X5 fueron identificados como determinantes independientes de la CVRS en los fumadores sin LFA. Conclusiones: La DPV es frecuente en fumadores sin LFA, afectando a un tercio de los mismos, y condicionando de forma independiente su percepción de salud

Introduction: Small airway dysfunction (SAD) caused by smoking contributes to the early onset of airflow limitation (AFL), although its impact on patients’ perception of health is largely unknown. We aimed to evaluate the frequency of SAD in active smokers without AFL, and to compare health-related quality of life (HRQoL) of non-smokers, smokers without SAD, smokers with SAD, and smokers with AFL. Methods: A total of 53 active smokers without AFL, 20 smokers with AFL, and 20 non-smokers completed the SF-36 and EuroQoL questionnaires and performed impulse oscillometry and spirometry. Pulmonary parenchymal attenuation was determined in inspiration and expiration. SAD was determined to exist when resistance at 5Hz (R5), the difference between R5 and R20, and reactance area (AX) exceeded the upper limit of normal. Results: In total, 35.8% of smokers without AFL had SAD. No differences were detected in spirometric parameters or pulmonary attenuation between smokers with or without AFL and non-smokers. However, smokers with SAD had worse scores on HRQoL questionnaires than smokers without SAD or non-smokers, and scores compared to smokers with AFL were intermediate. R5 and X5 were identified as independent determinants of HRQoL in smokers without AFL. Conclusions: SAD is common in smokers without AFL, affecting one third of this population, and independently affecting their perception of health

Small Airway Dysfunction Impairs Quality of Life Among Smokers With No Airflow Limitation. / La disfunción de las pequeñas vías aéreas deteriora la calidad de vida de fumadores sin limitación al flujo aéreo.

INTRODUCTION: Small airway dysfunction (SAD) caused by smoking contributes to the early onset of airflow limitation (AFL), although its impact on patients' perception of health is largely unknown. We aimed to evaluate the frequency of SAD in active smokers without AFL, and to compare health-related quality of life (HRQoL) of non-smokers, smokers without SAD, smokers with SAD, and smokers with AFL. METHODS: A total of 53 active smokers without AFL, 20 smokers with AFL, and 20 non-smokers completed the SF-36 and EuroQoL questionnaires and performed impulse oscillometry and spirometry. Pulmonary parenchymal attenuation was determined in inspiration and expiration. SAD was determined to exist when resistance at 5Hz (R5), the difference between R5 and R20, and reactance area (AX) exceeded the upper limit of normal. RESULTS: In total, 35.8% of smokers without AFL had SAD. No differences were detected in spirometric parameters or pulmonary attenuation between smokers with or without AFL and non-smokers. However, smokers with SAD had worse scores on HRQoL questionnaires than smokers without SAD or non-smokers, and scores compared to smokers with AFL were intermediate. R5 and X5 were identified as independent determinants of HRQoL in smokers without AFL. CONCLUSIONS: SAD is common in smokers without AFL, affecting one third of this population, and independently affecting their perception of health.

Small airway dysfunction in smokers with stable ischemic heart disease.

BACKGROUND: A higher prevalence of airflow limitation (AL) has been described in patients with ischemic heart disease (IHD). Although small airway dysfunction (SAD) is an early feature of AL, there is little information about its occurrence in IHD patients. Our objective was to describe the prevalence of SAD in IHD patients, while comparing patient-related outcomes and future health risk among IHD patients with AL, SAD and normal lung function. METHODS: In 118 consecutive smoking patients with stable IHD, comorbidities, utilization of healthcare resources, current treatment, blood biochemistry and health status were recorded. SAD was evaluated by impulse oscillometry, and pre- and post-bronchodilator spirometry was performed. RESULTS: The prevalence of AL and SAD were 20.3 (95% CI, 13.1-27.6%) and 26.3% (95% CI, 18.3-34.2%), respectively. Compared to the normal lung function group, patients with SAD and without AL had lower spirometric values, poorer quality of life and higher levels of C-reactive protein (CRP), as well as increased cardiovascular risk and more vascular age. In patients with normal spirometry, the presence of SAD was independently associated with pack-years, HDL-cholesterol and CRP levels. CONCLUSION: In patients with IHD, the presence of SAD is common and that it is associated with reduced health status and increased future cardiac risk.

Clinical, operational and economic outcomes of point-of-care blood gas analysis in COPD patients.

INTRODUCTION: Arterial blood gas analysis is relevant in chronic obstructive pulmonary disease (COPD) management. The aim of this study was to evaluate whether the use of a blood gas analyzer in pulmonology departments improves the clinical, operational and economic outcomes when compared with clinical laboratory measurements. PATIENTS AND METHODS: It is an observational prospective study. 112 patients were selected. After specimen collection, the measurement was performed both in pulmonology office as point-of-care and in laboratory. We evaluated clinical outcomes (modification of the indication of long-term oxygen therapy (LTOT) according to results, changes in blood gas analysis results, relationship of the partial pressure of oxygen (PaO2) obtained in the medical visit and velocity of change of the PaO2, influence of total haemoglobin concentration and the change in PaO2), operational outcomes (turnaround time (TAT) from specimen collection to receiving the blood gas analysis report) and economic outcomes (overall cost per process of patient care). RESULTS: There were discrepancies in the indication of LTOT in 13.4% of patients. All parameters showed changes. PaO2 levels showed changes in 2 ways, though they frequently increase over time. The correlation was not good in the other two clinical outcomes. The median TATs in pulmonology office were 1 min versus 79 in laboratory, with 52 min for specimen preparation and transport and 17 min for TAT intralaboratory. The overall cost for the 112 patients in pulmonology office and laboratory was 16,769.89€ and 22,260.97€ respectively. CONCLUSIONS: The use of a blood gas analyzer in a pulmonology office improves clinical, operational and economic outcomes when compared with clinical laboratory.

Estudio del bloque celular en el diagnóstico de adenopatías mediastínicas mediante ecobroncoscopia / Study of the cell block as a dignostic technic of mediastinal lymphadenopathies in ecobronchoscopy obtained samples

Introducción. La introducción de nuevas técnicas diagnósticas hace que la necesidad de muestras de tejidos de alta calidad sea cada vez mayor. El bloque celular (BC) es una técnica útil para este fin, pero no es aun ampliamente usada en ecobroncoscopia (EBUS) y existe poca información en cuanto a su valor diagnóstico adicional. Pacientes y métodos. Estudio prospectivo y descriptivo que analiza el aporte diagnóstico del BC a la citología convencional (CC) en pacientes con adenopatías mediastínicas mediante EBUS. Sobre las muestras obtenidas se realizaron estudios de microscopia óptica, inmunohistoquímica y biología molecular. Resultados. Se realizaron 47 EBUS obteniendo 42 muestras representativas (89,4%) y resultados patológicos en 24 casos (57,1%). Los principales diagnósticos fueron metástasis de carcinoma broncogénico (66,7%) y metástasis de carcinoma extrapulmonar (20,8%). El 23% de los casos se diagnosticaron solo por BC, y no hubiera podido diagnosticarse de no haber sido realizado el BC. Conclusiones. El proceso del BC en muestras de adenopatías obtenidas mediante EBUS es un procedimiento sencillo que puede realizarse en la mayoría de los casos. En esta serie ha aportado información diagnóstica y pronóstica adicional clínicamente relevante en casi una cuarta parte de los casos en los que se ha realizado (AU)

Introduction. The introduction of new diagnostic techniques requires high quality samples. Cell block (CB) is a useful tool in this respect, although it is still not widely used in ecobronchoscopy (EBUS) and there is little available data regarding its diagnostic value. Methods. A prospective and descriptive study was carried out to analyze the contribution of Cell Block processing to the conventional smears (CS) in samples of mediastinal lymphadenopathies obtained with ecobronchoscopy CB and CS were processed and diagnostic techniques of optical microscopy, immunohistochemistry and molecular biology were compared. Results. 24 pathology samples were obtained, mainly lung cancer (66.7%) and extrapulmonary cancer metastases (20.8%). In 26% of cases CS was insufficient for staining techniques and a diagnosis could only be made with CB. CB diagnosed 25% of the samples not-diagnosed with CS. Conclusion. Processing of CB additionally to CS in samples obtained with EBUS in this series has contributed with clinically relevant diagnostic and prognostic information in a quarter of all cases (AU)

Lung volume reference values for women and men 65 to 85 years of age.

RATIONALE: In elderly subjects, static lung volumes are interpreted using prediction equations derived from primarily younger adult populations. OBJECTIVES: To provide reference equations for static lung volumes for European adults 65 to 85 years of age and to compare the predicted values of this sample with those from other studies including middle-aged adults. We compare the lung volumes by plethysmography and helium dilution in elderly subjects. METHODS: Reference equations were derived from a randomly selected sample from the general population of 321 healthy never-smoker subjects 65 to 85 years of age. Spirometry and lung volume determinations by plethysmography and multibreath helium equilibration method were performed following the American Thoracic Society/European Respiratory Society recommendations. Reference values and lower and upper limits of normal were derived using a piecewise polynomial model. MEASUREMENTS AND MAIN RESULTS: Plethysmography provided higher values than the dilutional method for all lung volumes, with wide limits of agreement. In addition to height, our reference equations confirm the age- and body size dependence of lung volumes in older subjects. Practically all the estimations performed by extrapolating reference equations of middle-aged adults overpredicted the true lung volumes of our healthy elderly volunteers. Middle-aged reference equations classify subjects as being below the total lung capacity lower limit of normal between 17.9 and 62.5% of the women and between 12.5 and 42.2% of the men of the current study. CONCLUSIONS: These results underscore the importance of using prediction equations appropriate to the origin, age, and height characteristics of the subjects being studied.

[Prognostic value study of lung cancer molecular markers]. / Valor pronóstico de los marcadores moleculares en el carcinoma broncogénico.

BACKGROUND AND OBJECTIVE: The aim of this study was to determine the prognostic value of molecular markers (proteins) of different paths of lung cancer development in patients with non small cell lung carcinoma (NSCLC) in initial stages. MATERIAL AND METHOD: Observational, cohort study in patients with NSCLC that was initially treated surgically in our hospital between October 1993 and September 1997. Thirty-two proteins were selected. The study consisted of the elaboration of tissue arrays with samples from resected tumour, using a semiquantitative immunohistochemical study. A prognosis analysis was done with the expression of each protein and calculation of the overall 5-year survival rate. The Wilcoxon-Gehan and Log-Rank tests were used for statistical comparisons, with p<.05 being considered to indicate a significant result. RESULTS: One hundred and forty six patients were studied. The overall 5-year survival rate was 37.7%. From 32 proteins studied, three were statistically associated with overall 5-year survival rate. RB protein expression in resected NSCLC was a positive prognostic factor (P=.01). P27 (P=.03) and Ki67 (P=.04) expression in resected NSCLC were negative prognostic factors. There was no protein with prognostic value in epidermoid tumours. CONCLUSIONS: We found three proteins with long-term prognostic value in the long-term in the general population and five adenocarcinoma prognostic proteins in our study of resected non-small cell lung cancer (NSCLC). In the future, genetic-molecular factors should be included along with anatomical (TNM staging) and clinical factors in a multidimensional lung cancer staging.

Valor pronóstico de los marcadores moleculares en el carcinoma broncogénico / Prognostic value study of lung cancer molecular markers

Fundamentos y objetivo: Estudio pronóstico de marcadores moleculares implicados en la carcinogénesis del carcinoma broncogénico (CB), en pacientes con CB no microcítico (CBNM) resecado en estadios iniciales. Material y método: Estudio observacional y de cohorte de pacientes con CBNM en estadios iniciales intervenidos en el Hospital 12 de Octubre de Madrid entre el 1 de octubre de 1993 y el 30 de septiembre de 1997. Se estudiaron 32 proteínas con un análisis inmunohistoquímico semicuantitativo. Se realizó un análisis de la expresión de cada proteína en relación con la supervivencia a 5 años mediante las pruebas de Wilcoxon-Gehan y log rank, aceptando como significativo un valor de p<0,05.ResultadosEl número final de pacientes incluidos fue de 146. La supervivencia a 5 años fue del 37,7%. De las 32 proteínas, hemos encontrado tres con significado pronóstico a 5 años: la expresión de RB, asociada a mejor pronóstico (p=0,01), y la expresión de p27 (p=0,03) y Ki67 (p=0,04), asociadas a peor pronóstico. En el análisis según histología no hay ninguna proteína con valor pronóstico en CB epidermoide, mientras que hay cinco en adenocarcinomas. Conclusiones: En esta serie de CBNM resecado hay 3 marcadores moleculares con valor pronóstico a largo plazo en la población general y cinco en adenocarcinomas. Probablemente, en el futuro los factores moleculares se unan a los de extensión anatómica y clínicos en una clasificación pronóstica multidimensional en CB (AU)

Background and objective: The aim of this study was to determine the prognostic value of molecular markers (proteins) of different paths of lung cancer development in patients with non small cell lung carcinoma (NSCLC) in initial stages. Material and method: Observational, cohort study in patients with NSCLC that was initially treated surgically in our hospital between October 1993 and September 1997. Thirty-two proteins were selected. The study consisted of the elaboration of tissue arrays with samples from resected tumour, using a semiquantitative immunohistochemical study. A prognosis analysis was done with the expression of each protein and calculation of the overall 5-year survival rate. The Wilcoxon-Gehan and Log-Rank tests were used for statistical comparisons, with p<.05 being considered to indicate a significant result. Results: One hundred and forty six patients were studied. The overall 5-year survival rate was 37.7%. From 32 proteins studied, three were statistically associated with overall 5-year survival rate. RB protein expression in resected NSCLC was a positive prognostic factor (P=.01). P27 (P=.03) and Ki67 (P=.04) expression in resected NSCLC were negative prognostic factors. There was no protein with prognostic value in epidermoid tumours. Conclusions: We found three proteins with long-term prognostic value in the long-term in the general population and five adenocarcinoma prognostic proteins in our study of resected non-small cell lung cancer (NSCLC). In the future, genetic-molecular factors should be included along with anatomical (TNM staging) and clinical factors in a multidimensional lung cancer staging (AU)

Analysis of the molecular expression profile of non small cell lung carcinoma associated to chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is an independent risk factor to develop lung cancer but there are no different functional clusters of biomarkers between patients with non-small cell lung cancer (NSCLC) with or without COPD. To analyse protein expression, in order to find out whether samples of resected NSCLC from patients with COPD present a different molecular expression. Observational, cohort, concurrent study with sampling since treatment of disease in patients with NSCLC in initial stages (pIA-pIIB) treated surgically in our hospital between October 1993 and September 1997. The study consisted of the elaboration of tissue arrays with samples from resected tumor, using immunohistochemistry as a study method. Univariate analysis and logistic regression analysis were performed in order to determine molecular markers that showed a differential expression in NSCLC of the patients with COPD. We studied thirty-two proteins in 146 patients. 30% of the patients had COPD. Univariate analysis in patients with COPD showed one molecular marker to be overexpressed and five molecular markers to be underexpressed. Multivariate analysis in patients with COPD identified membranous beta-Catenin as a differential biomarker, which displayed an underexpression, with an Odds Ratio (95% Confidence Interval) of 0.26 (0.07-1.01). A significant lowest expression of membranous beta-catenin was detected in NSCLC of the patients with COPD.

Sarcoidosis cardiaca: diagnóstico por resonancia magnética con contraste / No disponible

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Análisis de las publicaciones sobre cáncer de pulmón en Archivos de Bronconeumología 2 años después de la designación del Año SEPAR del Cáncer de Pulmón / Lung cancer articles in Archivos de Bronconeumología: 2 years on from lung cancer year of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR)

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Derrame pleural por Listeria monocytogenes en mujer con cirrosis hepática / Pleural effusion due to Listeria monocytogenesin a woman with cirrhosis of the liver

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